Evolving student health priorities and school-based health-promoting interventions in Quebec, 2016–2025

INTRODUCTION: The World Health Organization (WHO) recommends implementing health-promoting interventions (HPIs) in schools to enhance student health and well-being. The repeat cross-sectional PromeSS project examines whether social inequalities are evident in perceived priority of student health concerns and in HPI availability in Quebec public schools. METHODS: We analyzed data from 171 primary (K-6) schools in PromeSS I (2016-2019) and 218 in PromeSS II (2023-2025), which updates findings post-COVID-19 and explores additional priorities. Principals or designated staff documented priority student health-related concerns and availability of related HPIs in structured interviews (PromeSS I) or online/paper questionnaires (PromeSS II). Data analysis emphasized descriptive comparisons. RESULTS: Perceived importance increased for unhealthy eating (+16%), inadequate sleep (+15%), physical inactivity (+13%), and mental health (+12%). HPI availability increased for mental health (+12%) and personal safety (+13%) but declined for physical activity (-13%) and dental health (-19%), despite government mandates. In 2023-2025, screen time was a universal concern (98%), but only three schools offered related HPIs. Sedentary behaviour was a common concern (51%), with 42% HPI availability. Three-quarters of schools implemented HPIs related to unsafe use of technology. Key challenges to HPI availability included insufficient staff (62%), funding (45%), and implementation support (35%). Few schools reported low engagement from staff, students, or families. CONCLUSION: From 2016 to 2025, concerns about student health grew, especially for mental health, inactivity, and nutrition. Yet HPI availability remains inconsistent. Increasing financial resources and implementation support is critical to align school health efforts with evolving needs.